Cholesterol and coronary events. The current thinking.

The clinical benefit of lowering levels of low-density lipoprotein cholesterol (LDL-C) in primary and secondary prevention of coronary heart disease (CHD) is well established, with the statins recognized as the drugs of choice. Updated guidelines from the National Cholesterol Education Program continue to recognize the importance of aggressive LDL-C lowering in patients with established CHD, as well as identifying CHD risk-equivalent patients who require the same aggressive LDL-C reduction in primary prevention. For such patients, optimal LDL-C levels are <100 mg/dL. The issue of whether LDL-C should be lowered substantially below 100 mg/dL in both types of patients remains unresolved but is being addressed by several ongoing end point trials. With existing statins and others expected soon, LDL-C reductions of more than 60% appear possible. The updated guidelines redefine high-density lipoprotein cholesterol (HDL-C) levels <40 mg/dL as a major CHD risk factor in both men and women, and also introduce non-HDL-C as another parameter that predicts CHD risk. Statins effectively reduce the components of non-HDL-C, and some members produce elevations in HDL-C approaching those achieved with fibrates. Accordingly, statin therapy is appropriate for a wide range of dyslipidemic patients.